MS-02-1082

healthy mindhealthy body

y o u r O x f o r d g u i d e t o l i v i n g w e l l

healthy mindhealthy body

Fall 2002

Saving antibiotics

Whole body healing

Understanding domestic violence

What goes oninside the house?

Did you know?That delicious mug of hot cocoa that warms your soul on a cold afternoon may

also be good for your heart. Researchers found that the island-dwelling Kuna people of

Panama, who drink an average of five cups of cocoa a day, rarely suffer from high blood

pressure, but when they move to the mainland and abandon their cocoa-drinking habits,

their risk of high blood pressure quickly increases to that of the mainland. Two recent

studies show that the flavones found in cocoa help the body maximize its use of nitric

oxide, a molecule critical to healthy blood flow and lower blood pressure. So go ahead,

give in to the urge. Treat yourself to a healthy cup of hot cocoa! O

The winter season is approaching and with it comes exposures that may induce or “trigger”

episodes of asthma. The common cold, flu, and other infections may intensify your

asthma. Speak with your physician to determine if you should receive a flu vaccine this fall.

Airborne irritants can also trigger episodes of asthma. Some common irritants include

tobacco smoke, smoke from wood stoves or fireplaces, fumes from gas stoves, certain

fragrances, and scented candles. Indoor allergens such as dust, dust mites, and animal

dander seem to cause more symptoms when the heat is turned on in a home or building.

Exercising in cold air can aggravate your asthma, so you should wear a scarf or mask over

your mouth when exercising in the cold. Holiday events may expose people with asthma to foods that can cause

symptoms. Often, these foods may not be obvious, but may have “hidden” ingredients, such as certain nuts, shellfish,

and fruits. Pay special attention to any exposures that could trigger an attack. Lastly, always keep a bronchodilator or

other medication handy, even if the weather and circumstances seem to support free breathing. O

Oxford has more of the best doctors than any other health plan as listed in New York Magazine’s 2002

“The Best Doctors in New York” issue. O

OO X F O R D H E A L T H . C O M

Link to Medco Health through www.oxfordhealth.comYou can view your pharmacy benefits, order prescriptions, and get important health and prescription benefit

information online. You also have the ability to:

• Compare medication pricing and coverage details for both brand name and generic medications, along with preferred alternatives

• Keep track of your prescription history and related expenses

• Find detailed drug information

• Review your account summary; check and pay balances

• Locate a participating retail network pharmacy

Once you begin using the Medco Health Home Delivery Pharmacy Service,™ you will also be able to use the Internet to:

• Refill and renew your home delivery prescriptions

• Track the status of your order

• View up to 18 months of detailed prescription history

These features are available to you now by visiting oxfordhealth.com and logging in to yourpersonalized home page. Simply click on theMedco Health icon to go to medcohealth.com.You can register by clicking on the “Registernow” button. Follow the on-screen instructions,making sure to enter the first nine digits of your Rx Member ID number from the lower left corner of your Oxford ID card. O

Access to prescription drug benefit information on medcohealth.com is available only for Oxford Members with prescription drug coverage through Oxford HealthPlans. Home Delivery Pharmacy Service is available for Oxford Members with a prescription drug benefit which includes mail-order prescription drug coverage.

y o u r O x f o r d g u i d e t o l i v i n g w e l l

Chief Executive Officer Norman C. Payson, MDPresident and COO Charles G. BergChief Medical Officer and EVP Alan M. Muney, MD, MHAVice President, Marketing Chuck GreenDirector, Member Marketing Rebecca MadsenManager, Member Marketing Meg DedmanEditor Stephanie GebingMedical Editor Alan M. Muney, MD, MHA

Healthy Mind Healthy Body® is published exclusively for Oxford Health Plans by:Onward Publishing, Inc.10 Lewis Road, Northport, NY 11768Tel 631-757-3030 Fax 631-754-0522

Publisher Jeffrey BaraschCreative Director Melissa BaraschEditorial Director Wendy MurphyArt Director Bruce McGowinDesigner Lisanne SchnellProject Management Tamyra ZieranBusiness Manager Liz Lynch

Oxford Health Plans, Inc., and Onward Publishing, Inc.,are not responsible for typographical errors.

This magazine provides general health information and,as such, is neither intended to replace the advice of your physician nor to imply coverage of referenced treatments or medications. Please consult with your physician regarding any treatment or medication that couldimpact your health before proceeding with it, and refer toyour benefit documents for specific coverage information.

© 2002 Onward Publishing, Inc. All rights reserved.

P R E V E N T I O N

Beating the flu bug

M E D I C I N E

Saving antibiotics — A cautionary tale

C O V E R S T O R Y

Behind closed doors —Domestic violence

P H Y S I C I A N S P O T L I G H T

Whole body healing — Dr. Kelly Cassano

W E L L N E S S

Heeding a wake-up call for diabetes

N E W S Y O U C A N U S E

Membership updates

L I V I N G W E L L

Making the most of your pharmacy benefit

4

5

6

10

13

14

19

healthy mindhealthy body

healthy mindhealthy body

Fall 2002

C O N T E N T S

1 4

Healthy Mind Healthy Body is designed just for you — to give you the latest information on a wide range

of health topics, as well as updates on your plan benefits. We encourage you to e-mail your comments to us at

publications@oxfordhealth.com, or write to: Oxford Health Plans, c/o Stephanie Gebing, 48 Monroe Turnpike, Trumbull, CT 06611.

5

6

Beatingthe f lu bug

Information used in this article was derived from the Centers for Disease Control (CDC).

P R E V E N T I O N4

While a cough or cold can be

unpleasant, coming down with

influenza, or the flu, is just plain

misery. And for some people —

over 65 or with long-term or chronic

health problems — the flu can be

life threatening. That’s because the

virus that causes it is far tougher

than any cold virus.

At the very least, the flu causes

severe body aches, cough, profound

fatigue, intense headache, and

often, a sore throat. In comparison to the worst cold,

the flu comes on faster and goes deeper into the body’s

systems. It can sometimes overwhelm the very immune

system that is supposed to help you recover. Instead of

gradually improving after the onset of flu, you may

experience second stage bronchitis, pneumonia, or

even inflammation of the heart and brain.

Fortunately, there’s a simple way to minimize the risk of

getting the flu, and that’s through an annual flu vaccine.

Yearly immunizations are needed because the particular

strain of virus is always changing. Immunizations offered

this fall were tailor-made in the laboratory over the preced-

ing months to stifle this year’s bug. However, no vaccine

can be 100% effective. So despite getting your annual

vaccine, it’s possible to encounter one of the less prevalent

strains of the flu. As for rumors that you can catch the flu as

a result of getting vaccinated, well, they’re just not true. Flu

vaccines are made from dead viruses, therefore they are not

likely to cause symptoms beyond the brief sore arm or mild

headache, though there are some exceptions. (See sidebar)

Each fall, we mail a flu vaccine reminder to all of our

Members over the age of 50 to emphasize the importance

of receiving this vaccination. This is part of our Active

Partner ® program, which is intended to help

Members achieve their best state of health.

If you receive a reminder, call your primary

care physician (PCP) to find out if and when

you can get your vaccine. Also ask if you’re

up-to-date on your protection for bacterial

pneumonia. Pneumococcal disease usually

gets its start after a serious upper respiratory

infection — a cold, sore throat, or flu.

Like the flu, it can be very serious in older

people, and its incidence can be sharply

reduced with an immunization. Although

its protection can last a lifetime, if you’re in a high-risk

category, your PCP may recommend a booster dose

every five to 10 years. O

OOX F O R D I N F O

T o g e t t h e f l u v a c c i n e o r n o t ?

Who should:• Most of us — not only to reduce our risk of illness, but to

lower the chance we’ll spread the flu to someone unprotected

• Children between six and 23 months old

• Any individuals who might be considered at high risk:• Persons aged 50 years and older

• Persons in long-term care facilities with other residents who have chronic health problems

• Persons who have serious long-term health problems with heart disease, kidney disease, lung disease, metabolic diseases, asthma, or anemia

• Persons whose immune system is weakened because of a disease that affects the immune system, long-term treatment with drugs such as steroids, or cancer treatment with X-rays or drugs

Who shouldn’t:• Anyone allergic to eggs • Anyone who has had a severe reaction to a previous flu vaccine• Anyone who has had a history of Guillain-Barre Syndrome • Anyone who has a fever or is severely ill

There are no charges for flu and pneumococcal vaccines administered by your primary care physician if these are theonly services provided during the visit. If additional services are rendered during your visit, a copayment may apply.

Saving antibiotics — A cautionary tale

Over time, as drug developers came

to understand bacteria and natural anti-

bacterial substances better, the number

and kinds of antibiotics grew. First, the

sulfa drugs appeared, then the penicillins,

streptomycin, and a collection of broad-

spectrum tetracyclines. More recently, we’ve

seen the addition of synthetic antibiotics —

the quinolones. With such a wealth of weapons to choose

from, some medical optimists forecasted that we were

close to winning the war on infectious diseases.

Sadly, they were wrong. In our enthusiasm for antibiotics,

physicians, patients, farmers, hospitals, and housewives

became habituated to them. Doctors prescribed them for

minor infections that would have resolved on their own

or gave them prophylactically “just in case.” Patients

demanded antibiotics for colds and sore throats —

almost always viral in origin and unresponsive to anti-

biotics. Meanwhile, the agricultural industry introduced

antibiotics to the routine production of milk and meat,

contributing further to our oversupply. And our quest

for a germ-free environment had hospitals and housewives

swabbing everything in reach with antibacterial soaps.

We are learning belatedly that in becoming awash

in antibiotics, we’ve not only suppressed many of the

“friendly” bacteria that help protect us, we’ve encouraged

dangerous new strains of bacteria to evolve. These new

bacteria are stronger and sufficiently different in the way

they grow so that the antibiotics we have don’t always work.

Children, the elderly, and all immunocompromised people

are already at a higher risk of becoming

more seriously ill because of resistance

problems. Now concerns about the return

of tuberculosis and other nearly forgotten

bacterial diseases have also been raised. And

the prospect of finding new antibiotics that

can deal with growing resistance is clouded;

it may take years, if not decades, and the

resulting drugs will be far more costly than our simpler

natural substances.

As a member of the Coalition for Affordable Quality

Healthcare (CAQH), Oxford is collaborating with the

Centers for Disease Control and Prevention (CDC) to

preserve the power of antibiotics. Save Antibiotic Strength

(SAS) is a program on both a national and local level

which educates patients about the threat of antibiotic

resistance and arms physicians with the information and

tools to support them in using antibiotics appropriately.

“The widespread prescribing of antibiotics when they are

not needed not only exposes patients to unnecessary side

effects, but also fosters the emergence of antibiotic-resistant

strains of infectious agents,” says Dr. Richard Petrucci, Vice

President Chronic Care and Disease Management. “We

know it is essential that we work together with physicians

and leading public health officials to provide educational

information to patients who are asking for antibiotics.” O

For more than 50 years, Americans have thought of antibiotics as magic bullets. Taken in a timely

fashion, we counted on them to make the most potent strains of bacteria surrender. Whether the

infection was bacterial pneumonia, tuberculosis, typhoid, or a festering toenail, the doctor usually

had something that restored you to your old healthy self. Veterinarians and agricultural food

producers started using inexpensive antibiotics liberally to prevent and cure infections, too.

5M E D I C I N E

RR E S O U R C E S

Log on to www.CAQH to learn moreabout antibiotic resistance and the Save Antibitoic Strength campaign.

S P E C I A L T O P I C6

7

Behind closeddoors —

Domestic violenceDomestic violence was once considered a “family matter,”

altogether private and rarely spoken of in public. Even

the police were reluctant to intervene or to “take sides.”

Now, however, domestic violence is openly recognized as

a serious public health issue with consequences affecting

all Americans directly or indirectly. And with that

understanding has come a whole network of social and

medical support services designed to help both the victim

and the victimizer end this dangerous and tragic form

of conflict. No one needs to suffer in silence any longer.

Much of the change in thinking is attributable to

the landmark “Violence Against Women Act,” passed by

Congress in 1994 and reauthorized in 2000. Among the

many consequences of the bill were grants to train police

and court officers, and funds to support state and local

victims’ services, crisis hotlines, and shelter programs,

as well as legal help and transitional housing aid.

Also funded were nationwide in-depth studies of the

dimensions of family violence. For the first time, it was

possible to get a statistical picture of just how widespread

domestic violence is. While no one is surprised to find

that women are indeed the prime victims of domestic

violence — 85% of recorded incidents involve adult

women as victims — it also became apparent that no

S P E C I A L T O P I C8

group, young or old, rich or poor, or of any particular

racial, religious, or ethnic background or sexual

orientation, are exempt. Patterns of abusive behavior

are fairly evenly distributed throughout every segment

of the population, though incidents occurring in

higher income families are less likely to be reported.

Responsible estimates of the number of women who

are physically abused by an intimate partner range

as high as three million annually. We know that the

actual numbers are substantially higher, but they often

go unreported because the victims are reluctant or

afraid to seek help.

As a company concerned with the physical and

mental well-being of our Members, Oxford recognizes

we all have a role to play in stopping domestic violence.

Through open discussions and readily accessible

support services, government, health organizations,

and individuals can and must do more to help both

the victims and the victimizers end this dangerous and

tragic form of conflict. We believe that a good place

to start is in educating everyone about what domestic

violence is, what its long-term consequences are, and

what treatments and resources are available to make

successful intervention possible.

The many faces of family violence Domestic violence is generally defined as a pattern of

controlling behaviors by one individual aimed at exerting

unwarranted power over another within an intimate

relationship — the victim may be a domestic partner, a

child, a parent, or a sibling. As the victimizer gradually

gains the upper hand, the victim becomes increasingly

demoralized, ashamed, frightened, and entrapped —

so that seeking any sort of refuge seems less and less

possible. This further enables the abuser to continue the

hostile behavior. What may begin as a subtle, passive form

of abuse tolerated by the non-confrontational victim can

escalate into increasingly violent and frightening episodes.

Even when serious injury occurs, and members of the

family end up in an emergency room, it is not uncommon

for the victim to fabricate some other explanation for

how the injury occurred. Astonishingly, some abusive

relationships fester until they climax in the violent death

of the victim. On average, three women are murdered

each day by an abusive mate in the United States.

Domestic abuse can take many forms, and is often

delivered on several fronts at once. Physical and sexual

abuse — which send some tens of thousands of victims

to the hospital or doctor’s office each year — are only

the most visible and well-documented forms. Emotional

abuse can leave equally lasting psychological scars; such

abuse consists of verbal insults and constant vicious

criticism, with the goal of humiliating the victim. As

self-esteem diminishes the victim gradually becomes

persuaded that any sort of abuse is “deserved.”

Isolation or jealous rages, in which the abuser works

to separate the victim from family and friends, further

intensifies the victim’s dependence on the abuser. With

no one to talk to, the victim feels abandoned and without

access to the emotional support it takes to leave the

abusive situation. The abuser may also threaten to take

or harm the children in the house to gain passive

cooperation. Statistics show that 50% of the men who

abused their wives also frequently abused their children.

Economic abuse, in which the victimizer makes every

expenditure the basis for another angry fight, can render

the victim a virtual slave.

9

As the door has been opened on domestic violence,

the broader impact it often has on families is becoming

better understood. We now know that abusive behavior

is statistically associated with other public health

problems either as a cause or result; these include

substance abuse, alcoholism, sexual assault, mental

illness, homelessness, suicide, and a widening circle of

physical and emotional health problems in succeeding

generations. In families where the parents are them-

selves engaged in a dysfunctional relationship, the

children have a high likelihood of perpetuating the

same models. Some will become abusers in adolescence

or adult life; others will seek out adult relationships

where they themselves are abused again. Feeling

unloved and abandoned by their own parents, many

children suffer from post-traumatic stress disorder and

have a very difficult time forming healthy relationships

with their own children, as well. Children who have

experienced abuse have a 40% higher risk of

delinquency and adult criminality.

The good newsFor better or for worse, we now know that solving

abusive relationships is not something to be left to

amateurs. Family members cannot hope to change the

abuser’s behavior by simply naming it and demanding

that the abuser stop. Genuine abusive behavior involves

a complex set of individual, situational and social factors,

all of which must be addressed by professionals trained

in the diagnosis and treatment. The complicating factors

may involve alcohol or drug abuse, a history of violence

in the abuser’s family of origin, depression, and culturally

supported attitudes of sexism and violence toward

women. Until recently, wife beating was an accepted

part of marriage in many societies.

One of the fundamental changes that must be

brought about in abusers is acceptance of personal

responsibility for their behavior, and this often takes

extensive counseling. The typical abuser sees the

“fault” in the victim, and their own “loss of control”

as a natural and inevitable response to the stress others

are causing them to feel. Yet, even when the victim tries

to circumvent abuse by doing exactly what is asked,

the abuser simply changes the rules and finds new

reasons to batter.

Where to go for helpThe first recourse for a person in an abusive relation-

ship is to find help and protection outside the situation.

Know the national and community resources that can

help. The National Domestic Violence Hotline can be

reached at 800-799-7233 (SAFE) or for the hearing and

speech impaired TTY/TDD 800-787-3224. They will

refer callers directly to appropriate help in the local

community. Support may include emergency services,

shelters, or referrals to health and social service agencies,

relocation assistance, child protective services, alcohol

and drug recovery programs, support groups, and

programs that can assist with job training and placement

for individuals who need to re-enter the job market.

A person in an abusive relationship should inform a

trusted family member or friend of his or her concerns,

as well as someone in the workplace if they fear the

abuse will follow them to work. Domestic violence

experts also strongly recommend that individuals at risk

of serious physical abuse develop a comprehensive plan

for leaving on short notice, should a dangerous situation

seem imminent. This may include having essential

papers — bank book, driver’s license, children’s birth

certificates, personal phone list, and the like — stored

in a handy place so that they can be grabbed on the run.

And do not hesitate to call 911. O

RR E S O U R C E S

Connecticut Coalition Against Domestic Violence90 Pitkin Street, East Hartford, CT 06108860-282-7899

New Jersey Coalition for Battered Women1670 White Horse Hamilton Sq. Road,Trenton, NJ 08690609-584-8107

New York State Coalition Against Domestic Violence79 Central Avenue, Albany, NY 12206518-432-4864

P H Y S I C I A N S P O T L I G H T 10

Whole body healing—Dr. Kelly Cassano

When Kelly Cassano set out for medical school, she took what is for

most physicians an unconventional path: She chose to become a

doctor of osteopathic medicine (DO). For her, it just made good

sense. DOs are physicians who are licensed to prescribe medication,

perform surgery and undertake all of the same treatments as

traditional MDs. The majority of DOs are family-oriented primary

care physicians and are fully integrated into the medical

community. But DOs bring something different to the practice

of medicine than some traditional MDs. Osteopathic physicians

practice a “whole person” approach to medicine, treating the entire

person rather than just the symptoms. With a focus on preventive

healthcare, DOs help patients develop attitudes and lifestyles

that don’t just fight illness, but help prevent it, too.

11

“I see osteopathic medicine as the perfect balance,” says Dr.

Cassano. “We are trained to think of the entire body as a system

in which one part supports the other. We also recognize that the

body has an innate capacity to maintain and heal itself, but that

sometimes an adverse event occurs that is sufficient to overwhelm

these healing powers — say a physical injury, or an infection, or

some emotional disruption. That event can trigger a cascade of

small physical and chemical changes we try instinctively to

accommodate as best we can. So, as a doctor seeking to heal

the patient, I need to take a holistic approach. Another way to

describe osteopathy is to say that it’s patient-centered, rather

than disease-centered.”

“I first became aware of osteopathy when I was in undergraduate

school studying to become a writer,” Cassano explains. “I had

always been involved in sports, so to earn extra money for school

I took a part-time job as a sports trainer. That got me curious

about sports injuries and how they affected athletes. One time,

I recall a football player who came in with a twisted ankle. A week

later, with the ankle improving, he complained of a new pain

in his hip. It seemed to me that the two problems were not

coincidental but related somehow, as though in accommodating

to his ankle injury he had somehow put a strain on the hip. About

the same time, I met a couple of osteopathic doctors and found

out that their philosophy and training routinely addressed these

situations and that they could often anticipate, and then prevent,

these kinds of sequential effects. That caught my attention and I

chose to become an osteopath.” In addition to treatments used by

conventional physicians, osteopaths add a unique hands-on tech-

nique of manipulation of the

skeleton and muscles known

as osteopathic manipulative

treatment (OMT).

Cassano attended the

University of New England

College of Osteopathic

Medicine in Biddeford,

Maine, receiving her DO, or

Doctor of Osteopathy, in 1993.

O s t e o p a t h y t o d a y

Osteopathic medicine is a philosophy of healthcare as well as a distinctive treatmenttechnique. Its basic premises were formulated in 1889 by frontier doctor Andrew Taylor Still,who had become disillusioned with the resultsof conventional medicine as practiced in his day. (Orthodox medicine had failed to savethree of his own children who died of spinalmeningitis.) Convinced of the interrelationshipof the body’s structure (anatomy) and function (physiology) in health and disease, he foundedthe first college of osteopathy in Kirksville,Missouri, in 1892 to train like-minded students.

There are currently some 45,000 practicingosteopaths in the U.S., more than half of them in primary care. (This compares with 650,000practicing MDs, of whom perhaps 45% are inprimary care.)Though osteopathy was slow to gain acceptance in some quarters in its early years, it has over time developed into a rigorous discipline, requiring seven years of medical training; fully as research-based as that of allopathic (conventional Western) medicine.Today, DOs are fully licensed in all 50 states andrepresented in all practice specialties.They areroutinely found on the staffs of public and private hospitals throughout the country.

P H Y S I C I A N S P O T L I G H T 12

She followed with residency training in internal medicine at

St. Vincent’s Hospital and Medical Center in New York City,

where she also found time to do some community medicine

with the homebound elderly and the homeless. She became

board-certified in internal medicine in 1994, and subsequently

joined a private group practice in the city, affiliated with nearby

St. Luke’s-Roosevelt Hospital Center.

Asked if she considers herself a “classical osteopath” in her

approach to patients, Dr. Cassano thinks not. “It’s hard to be a

purely ‘classical’ osteopath any more,” she says, by which she

means a DO who relies primarily on OMT. “OMT can be terrific

in relieving short-term pain and structural problems,” Cassano

continues, “and I still see its underlying philosophy as valid, but

it does not solve long-term chronic problems like asthma. I

would describe my method as more dynamic and multifaceted.

I spend a lot more time addressing the nutrition and exercise

needs of my patients, but like conventional physicians, I do not

hesitate to provide medications when I think they are warranted.

And after I’ve done a thorough physical work-up, I ask a lot of

questions about home, work, and family life that might seem

outside the usual scope of medicine.”

Cassano explains that she’s always listening for clues to

emotional well-being: “It’s clear that the emotions interact with

physical well-being and vice versa. You can treat and treat and

treat low back pain, for example, but if your patient is in a bad

place psychosocially, and you don’t do something to help the

patient rebalance — to replace destructive attitudes and lifestyles

with more affirming ones — the back pain is likely to remain

the same or get worse over time.”

Her patients really appreciate her caring, thoughtful approach.

“She’s just the best,” says one Oxford patient who has been going to

Dr. Cassano for several years. “Her treatment begins with asking the

right questions and being incredibly good at hearing the nuances of

what you’re saying. She helps you get to issues that you may not have

seen before but which may be contributing to whatever ails you. She

never preaches about adopting healthier lifestyles or doing things

differently, but when you come away from an appointment you

know you can and want to do more to keep yourself healthy.”

“Yes, it takes a little extra time to get to this place with patients,”

Cassano admits, “but I can’t imagine practicing any other way.” O

A G r o w i n g F i e l d

DO growth has been consistent over the years,outpacing MD growth by almost two timesbetween 1989 and 1994. By 2020, the number of practicing DOs is expected to be 80,000.

YEAR TOTAL DOs* DOs PER 100,000

1980 18,820 8.28

1985 24,014 10.09

1990 29,384 12.40

1995 36,508 13.89

2000 45,800 16.71

* DO totals include retired and disabled physiciansSource: Population data,Woods & Poole Economics, Inc.,in Washington, DC; growth data, Lanis Hicks, PhD,University of Missouri, “Forecast of Osteopathic Manpower.”

RR E S O U R C E S

American Osteopathic Association

142 East Ontario Street

Chicago, IL 60611

800-621-1773

www.aoa-net.org

American Academy of Osteopathy

3500 DePauw Boulevard

Suite 1080

Indianapolis, IN 46268

317-879-1881

www.academyofosteopathy.org

13W E L L N E S S

Type 2 or non-insulin-dependent diabetes mellitus

has lately taken on epidemic proportions in the U.S.

Approximately one million new cases are diagnosed each

year, making it the nation’s leading cause of blindness,

kidney failure, and limb amputation. Diabetes is also a

major risk factor for heart disease, high blood pressure,

and chronic nerve damage. By the time the first classic

symptoms of the disease appear — excessive thirst, the

frequent need to urinate, and persistent fatigue — some

damage has already been done.

Consequently, this past March the Department of

Health and Human Services and the American Diabetes

Association issued a new set of guidelines to help PCPs

identify what they termed "pre-diabetes." In sounding

the alarm, these experts hope to prompt people on the

road to diabetes to make whatever changes in diet and

lifestyle they can now, to avoid or at least postpone the

development of full-blown diabetes later.

There are several predisposing factors to pre-diabetes.

Family history, as well as advanced age and Asian, Hispanic,

Native American or African heritage, all contribute their

share of risk. But the greater influences lie in our modern

life habits — from consuming too many calories and gain-

ing weight to getting little exercise and internalizing more

stress. The good news is that these habits can be changed.

What’s a body to do?With type 2 diabetes, the body is unable to use glucose —

the simple sugar released from many foods in our diet — to

give muscle and fat cells the energy they need to carry out

their work. The natural hormone insulin, produced in the

pancreas and charged with regulating the use and storage

of glucose, is the key. With type 2 diabetes, the insulin is

either insufficient in the quantity made or the body

becomes progressively resistant to its effects. As a result,

little or no glucose reaches storage, but it is delivered

straight into the bloodstream at above healthy levels. Once

there, the glucose overburdens organs and systems until they

become irreversibly damaged. The objective of pre-diabetes

screening is to detect signs of impaired glucose tolerance and

to correct it so that sugar levels return to normal.

There are two standard tests performed for pre-diabetes:

a fasting glucose test or an oral glucose tolerance test

(OGTT). Both tests require several hours of fasting and

are usually done early in the day after skipping breakfast.

With the OGTT, a drink containing a fixed amount of

glucose is taken and the blood is measured at intervals to

see how well sugar levels are regulated when challenged.

During a fasting glucose test, blood is drawn to determine

the fasting blood glucose level.

A person with normal glucose tolerance will have a fasting

blood glucose level of less than 110 mg or less than 140 mg

after an OGTT. A person with impaired fasting glucose will

produce a reading of greater than 110 mg but less than

126 mg during a fasting glucose test or between 140 mg and

200 mg after an OGTT. These are considered the signs of

a possible candidate for pre-diabetic intervention. Anyone

with a level over 126 mg during the fasting glucose test or

over 200 mg during the OGTT is in the abnormal range

and, after further testing, will almost certainly be determined

to have full-blown diabetes. A slightly different test and set of

results apply in the condition known as gestational diabetes,

which occurs in one to three percent of pregnancies.

If pre-diabetes is detected, your doctor will work with

you to reach and/or maintain your ideal body weight,

to develop a daily exercise program, and to adopt more

healthy eating habits. Some recent studies indicate that if

lifestyle interventions are not successful in restoring glucose

levels back to normal, a medication such as metformin,

which increases the body’s response to its own insulin,

might be useful. Whatever the course of treatment,

following it carefully can make all the difference in long-

term quality of life. O

OOX F O R D I N F O

Our Living with DiabetesSM program offers educational materials and case management support to help Membersunderstand and improve control of their diabetes.For more information about the program, please call 888-585-0631, Monday though Friday, 8:00 AM to 4:30 PM.

Heeding aWake-up

Callfor Diabetes

N E W S Y O U C A N U S E14

Membership updatesA summary of Oxford’s Confidentiality Policy

Oxford is committed to maintaining the confidentiality of its Members’

protected health information (PHI). PHI is any information, which relates

to an individual’s physical or mental condition, medical history, or medical

treatment. PHI also includes any information obtained by Oxford from

which judgments can be made about a Member’s character, habits, avocation,

finances, occupation, general reputation, credit, health or any other personal

characteristics. Such information includes a Member’s name and address.

Consent obtained during the enrollment process covers

use and disclosure of PHI for purposes of treatment,

payment and healthcare operations, including quality

assessment and measurement, and disease management

activities. Before any PHI is disclosed for purposes of

treatment, payment or healthcare operations, agreements

with the recipients of such information are entered into

to protect the confidentiality of PHI.

All Members have the right to access, obtain copies

(within 30 business days of a request), and correct any

PHI about them, which is in Oxford’s possession.

PHI can be released to a third party upon prior receipt

of a valid written consent from the Member in question.

To be valid, a written consent must:

• Be signed by the Member

• Contain the Member’s name and Oxford ID number

• Be dated

• Specify the information to be disclosed

• Specify to whom the information can be disclosed

If a Member is unable to give consent, family or legally

appointed representatives will be authorized to release

and/or receive access to information about the Member.

Although it is Oxford’s policy not to release PHI to any

third party without the Member’s written consent, there

are exceptions, the most common of which are:

• To the Member directly

• To providers/physicians treating the Member

• To an applicable regulatory body

• To a law enforcement or other governmental authority

It is Oxford’s general policy not to share PHI with any

employer without consent from the Member. When

Oxford is obligated to

share information with

employers for auditing

and other purposes, such

information is either de-

identified or a certifica-

tion is provided by the

employer/group health

plan acknowledging that

the information can be

used only for plan

administration functions

and not for employment-

related purposes.

The sale of PHI is strictly prohibited. This information

will also not be disclosed for marketing purposes, for

purposes related to a workers’ compensation claim or

auto insurance claim, or for research studies, unless

the Member to whom the information pertains has given

specific written consent allowing disclosure.

15

We emphasize the importance of confidentiality through

employee training, the implementation of procedures

designed to protect the security of our records, and our

privacy policy. We restrict access to PHI to those employees

who need to know that information to perform their job

responsibilities. We maintain physical, electronic, and

procedural safeguards that comply with federal and state

regulations to guard the confidentiality of PHI.

NCQA excellent accreditationIn March 2002, the National Committee for Quality

Assurance (NCQA) again awarded an “Excellent”

Accreditation to Oxford for its commercial products in

New York. Oxford’s commercial products in New Jersey

and Connecticut were upgraded to an “Excellent”

Accreditation from “Commendable.” Oxford continued to

improve in most clinical performance measures, including

comprehensive diabetes care and ambulatory follow-up

care after behavioral health hospitalization.

Earning NCQA’s “Excellent” Accreditation status — the

highest accreditation level — is a significant achievement,

only awarded to health plans that meet or exceed NCQA's

rigorous requirements for consumer protection and

quality improvement.

2002 Member Satisfaction Surveyresults are in!

Recently, the results of the 2002 National Committee for

Quality Assurance (NCQA) Member Satisfaction Survey

were reported. Compared to 2001, Member opinions of

Oxford improved in several areas, including higher overall

ratings of participating primary care physicians. Assessments

of the amount of time doctors spend with Oxford Members,

physician attentiveness, and provider office staff courtesy all

improved, as did the amount of time Members reported

needing to schedule appointments for routine or preventive

care. In New York, Member ratings of the healthcare they

receive place Oxford among the top 10% of health plans

nationally, while ratings of Oxford as a health plan remain

in the top quarter.

While ratings of Oxford’s customer service and claims pro-

cessing still have room for improvement, Oxford continues

to make significant progress in these areas. Members in

Connecticut gave Oxford better ratings for customer service

this year while New Jersey Members provided Oxford with

higher marks for claims processing. We hope that continued

improvements throughout the company, including outreach

efforts with providers to further enhance the Member

experience, will lead to even higher overall ratings in the

next NCQA Member Satisfaction Survey.

Submission time frames for claims and appeals

The time frame for submitting claims for reimbursement

is 180 days1 from the date of service. Please submit your

claims in writing to:

Oxford Health PlansAttn: Claims DepartmentP.O. Box 7082Bridgeport, CT 06601-7082

As a reminder, please note that you also have

180 days to submit appeals if you disagree with

the resolution of a claim. Please submit claims-

related appeals in writing to:

Oxford Health PlansAttn: Correspondence DepartmentP.O. Box 7073Bridgeport, CT 06601-7073

The time frame for submitting clinical

appeals is also 180 days. If you disagree with

a decision rendered by Oxford’s Medical Management

Department, please submit your appeal in writing to:

Oxford Health PlansAttn: Clinical AppealsP.O. Box 7078Bridgeport, CT 06601-7078

1 Unless you are legally incapacitated and unable to submit the claim. For Members of New York insurance products underwritten by Oxford Health Insurance, Inc.,if it is not reasonably possible to submit claims within 180 days of the date of service, such claims must be submitted as soon as reasonably possible thereafter.

N E W S Y O U C A N U S E16

Overview of HIPAA What is HIPAA?

The Health Insurance Portability and Accountability

Act (HIPAA) of 1996, also known as the Kennedy-

Kassebaum Act is legislation intended to assure the

portability of health insurance, reduce healthcare fraud,

guarantee the privacy and security of health information,

and standardize healthcare industry transactions.

Who is affected?

HIPAA affects health insurance companies, physicians

and hospitals, as well as business associates of these

entities. Members and employers are also affected.

Privacy overview

While compliance with this portion of the law is not

required until April 2003, Oxford initiatives are already

underway to assess our current privacy controls to

assure compliance. Early next year, you will receive more

information about how to exercise your new rights, which

will be effective April 14, 2003. The HIPAA privacy rule

provides the first comprehensive federal protection of

protected health information (PHI). The regulation will

protect all health information, including demographic

data, created or used by providers and health plans, which

relate to a health condition, the provision of healthcare,

or payment for the provision of healthcare, and which

either identifies the individual or could reasonably be

used to identify the individual. Examples of PHI include

enrollment forms, referrals, authorizations, claims, and

responses to inquiries from providers.

The privacy rule will give consumers more control over

their PHI and allow them to find out how it is used, and

to whom it is disclosed. It will limit release of PHI to the

minimum information necessary for a particular purpose.

If state laws provide stronger protections, those stronger

protections will govern.

Oxford has always maintained confidentiality and

security policies to protect a Member's PHI. Please refer

to A summary of Oxford Health Plans’ Confidentiality Policy

on page 14 to learn how Oxford currently emphasizes

the importance of confidentiality. We are in the process

of validating or updating policies and procedures to be

fully compliant with HIPAA.

Transactions and security overview

HIPAA also addresses the extensive requirements

surrounding the electronic exchange of data. Compliance

with HIPAA transaction requirements is required by

October 16, 2003. Fully defined security regulations have

not been released. Compliance for security will be required

two years after the release date of the final regulations.

Going forward

A core team of Oxford personnel is working to develop

policy, procedural and system changes needed to make

Oxford fully compliant with HIPAA regulations. We will

continue to provide you with updates regarding our

compliance with the law as we move into 2003.

2002 Drug Formulary UpdateThe following is an update to the Preferred Drug List (PDL) for Oxford's three-tier prescription drug benefit. The

following recently approved FDA medications were reviewed by the Pharmacy and Therapeutics Committee in May 2002.

Therapeutic Class Preferred Brand Non-Preferred Brand Oxford PDL 2002Therapeutic Alternatives

Antihistamine/Decongestant Zyrtec-D Allegra-D

Antiviral Agents Rebetol Rebetol

Non-Narcotic Analgesic Ultracet pentazocine/APAP, pentazocine/naloxone

Oral Contraceptive Yasmin Ortho-Cept, Ortho-Cyclen,Yasmin

17

Merck-Medco name change Merck-Medco Managed Care, L.L.C., changed its

name to Medco Health Solutions, Inc., effective July 1,

2002. Your prescription benefit coverage will not change

as a result of the name change and you do not have to

do anything differently to obtain your prescriptions. In

fact, you can continue to use your current Oxford

Member ID card if you go to a retail pharmacy to fill

your prescriptions. If you use the Medco Health Home

Delivery Pharmacy Service™ (formally Merck-Medco

Home Delivery Pharmacy Service™) to fill your

prescriptions, you can continue to use the same

order forms and envelopes as you have in the past.

Merck updates Vioxx labeling The Food and Drug Administration (FDA) has required

Merck to add a precaution to its product labeling for

Vioxx warning doctors to exercise caution in using Vioxx

in patients with a history of ischemic heart disease. This

new precaution is based on results from the VIGOR

study, which showed that patients on Vioxx experienced

a higher incidence of serious cardiovascular events as

compared to patients on naproxen. Examples of serious

cardiovascular events included sudden death, myocardial

infarction, unstable angina, and ischemic stroke. Vioxx

is also associated with an increased incidence of peripheral

edema, mean systolic blood pressure and thromboembolic

cardiovascular adverse events.

Vioxx should not be used as a substitute for aspirin for

cardiovascular prophylaxis due to its lack of platelet effects.

Antiplatelets should not be discontinued in patients taking

Vioxx and antiplatelet therapy should be considered in

patients who are candidates for cardiovascular prophylaxis.

The use of Vioxx 50 mg for more than five days in the

management of pain has not been studied. Chronic daily

use of Vioxx 50 mg is not recommended. If you have any

questions, please speak with your physician.Referenced from: Vioxx package insert.Whitehouse Station, NJ: Merck & Co.,Inc.; 2002.Whelton,A., et al, Am. J.Ther. 2001, 8:85-95

Precertification reminderIf medical services require precertification, also known as

prior authorization, this means that you or your physician

must submit a formal request and receive approval from

Oxford before the services are obtained. Not all services

require precertification. If you are seeking services from an

in-network provider, he or she is responsible for knowing

whether the service requires precertification, and obtaining

precertification approval from Oxford for these services. If

you have out-of-network benefits and are seeking services

from an out-of-network provider, it is your responsibility to

know whether the service requires precertification, and to

precertify the procedures yourself by calling Oxford

Customer Service at the number on your Oxford ID card.

Although an out-of-network provider may offer to do this

for you, you are ultimately responsible to ensure that prop-

er precertification is obtained for out-of-network services.

Experimental procedures

In general, experimental procedures, investigational

treatments, and clinical trials are those treatments and pro-

cedures that have not been approved by the Food and

Drug Administration (FDA) and are not generally recog-

nized as the accepted standard treatment for a disease

or condition. Experimental procedures may involve treat-

ments for cancer. Precertification from Oxford is required

for all experimental procedures. As a Member, there may

be times when you are not aware that you are involved in

an experimental procedure. If you are asked to sign a

lengthy informed consent in connection with a procedure,

are informed that the treatment is not the standard of

care, or are asked to participate in a clinical trial, it is

likely that the treatment is an experimental procedure

and precertification is required. You should also be aware

that depending on your benefits, Oxford may not cover

certain experimental procedures.

When you or your provider are requesting precert-

ification from Oxford for out-of-network treatment that

may be experimental, you must ensure that Oxford is

informed of the exact type of service you will be receiving

and that Oxford’s precertification covers the exact service

requested. For example, it is not enough for Oxford

to be informed that you will be receiving in-patient

chemotherapy if the specific chemotherapy you will

be receiving is an experimental procedure. Although

Oxford would usually approve chemotherapy or notify

a Member that precertification is not required for

chemotherapy (depending upon your benefits),

without information about the specifics of the treatment

(i.e., you are receiving a higher experimental dose of

N E W S Y O U C A N U S E18

chemotherapy), Oxford will not be able to assess whether

the proposed treatment is experimental and would

require precertification. Also, receiving precertification

ensures that Oxford will provide coverage for treatment

in a specific care setting. Such an authorization will not

necessarily cover the treatment if received in a different

setting. If the authorization does not cover the specific

type of treatment you receive, or the setting in which you

receive it, you may not receive coverage for the service.

If you have questions about whether a specific

treatment requires precertification from Oxford, or

you would like to request precertification, please call

Customer Service at 800-444-6222, or refer to your

Certificate of Coverage and Summary of Benefits.

New York Women’s Wellness Law The New York Women’s Wellness Law will go into effect

on January 1, 2003, requiring all HMOs and insurers to

provide female Members with coverage for certain services.

• The health plan must provide the Member direct access

to their selected, qualified provider of OB/GYN care

without a referral. Members may access their OB/GYN

for the following: any care related to pregnancy; two

well-woman examinations per calendar year; any services

required as the result of an examination (related follow-

up); and any acute gynecological condition. Oxford

currently complies with this law by providing female

Members guaranteed access to their selected OB/GYN.

• The health plan must provide coverage for any

increased frequency of mammograms when a certain

family history of breast cancer is present. This is also

currently available through Oxford’s coverage.

• The health plan must provide coverage for bone density

measurement, as well as prescription drugs and devices for

related conditions (drugs and devices are covered only if

your employer has purchased a prescription drug rider).

• The health plan must provide coverage for birth control

drugs and devices under any outpatient prescription

drug rider. Once this law goes into effect, Oxford will

no longer sell a prescription drug rider that does

not include coverage for prescription contraceptives

(unless the group is a religious organization that does

not wish to provide such coverage). Members who are

not already receiving these benefits will be eligible for

the new benefits when their coverage renews on or

after January 1, 2003.

How to obtain emergency careMembers who seek emergency room (ER) care for

medical emergencies are not required to notify Oxford

of the visit if they are treated and released. If the Member

is released, it is his or her responsibility to pay the

applicable emergency room copayment at the time of

the ER visit. However, if the Member is admitted to the

hospital through the ER, the copayment will be waived.

Notification still required for inpatient hospital admissions

If a Member is admitted to the hospital through the

emergency room, Oxford requires notification. This

enables Oxford to work with the admitting hospital

to help ensure coverage and prompt claims payment.

The Member or a family member should notify Oxford

within 48 hours (or as soon as possible, if the patient is

unable to notify us within 48 hours as a result of a medical

condition). To notify us, call our Customer Service

Department at the number on your Oxford ID card, or

call 800-444-6222, Monday through Friday, 8 AM to 6 PM.

Emergency conditions

Emergency medical conditions generally are conditions

that, without immediate medical attention, could result in

serious injury to one’s health (or, in the case of a pregnant

woman, the health of her unborn baby), serious impair-

ment to bodily functions, serious dysfunction of any bodily

organ or part, or serious disfigurement. Emergency medical

conditions are often indicated by acute or severe symptoms.

Healthcare guidance through Oxford On-Call®

In the event of an emergency, Members should call

911 or go to the emergency room. For less serious

matters, we encourage Members to contact their primary

care physician (PCP). If Members cannot reach their

PCP, we offer Oxford On-Call, at 800-201-4911. Our

On-Call registered nurses are available 24 hours a day,

seven days a week, to offer healthcare guidance. If it is

determined that an emergency room visit is the best

course of care, the Member’s PCP or the On-Call nurse

can call ahead to alert the hospital of the Member’s

upcoming arrival.

19L I V I N G W E L L

Making the most of your pharmacy benefitPrescription drug costs are

on the rise. However, in the

last 30 years generic drugs have

offered Americans a substantial

cost savings opportunity. Since

1970, the Federal Food and

Drug Administration (FDA)

has approved almost 8,000

generic prescription drugs for

sale in the United States, and

every year more than 400

million prescriptions are filled

with generic medications.

Generic drugs defined

According to the FDA’s Office of Generic Drugs, in

order for a generic drug to gain FDA approval, it must:

• Contain the same active ingredients as the brand

name drug (inactive ingredients may vary)

• Be identical in strength, dosage form, and route

of administration, to the brand name drug

• Have the same use indications as the brand

name drug

• Be bioequivalent to the brand name drug

• Meet the same batch requirements for identity,

strength, purity, and quality as the brand name drug

• Be manufactured under the same strict standards of

the FDA’s good manufacturing practice regulations

required for brand name drugs

Once the patent for a drug expires, the pharmaceutical

firm no longer has the exclusive right to make the drug

and market it to the public. At that point, the drug can

be manufactured and sold by other pharmaceutical firms

as a “generic” drug.

The quality of generics

All generic medications are required to have FDA

approval. Unlike many products labeled “generic” which

are not tested for quality by government agencies, the

FDA requires that all drugs, including generic drugs, be

safe and effective. To meet FDA

standards, generic drugs must

be both bioequivalent and pharma-

ceutically equivalent to the brand

name drug. Bioequivalent generic

drugs have the same medical effect

as its brand name equivalent. The

FDA determines this by measuring

the rate and extent of drug absorp-

tion in the body. Drugs that meet

this requirement are considered

pharmaceutically equivalent.

Generic drugs that meet both these

standards are considered therapeutically equivalent and

are generally approved for sale. O

F A Q s & A n s w e r s

Q Are generic drugs really the same, or are theycheap imitations of the brand name?

A The active ingredients in brand name and generic productsare the same, and the FDA says that generic drugs are justas safe as their brand name counterparts. Since generics use the same active ingredients and are shown to work thesame way in the body, the FDA believes that they have thesame risks and benefits as their brand name counterparts.FDA regulations require that generic medications be madewith the same standards of purity, stability, strength, andquality as corresponding brand name drugs.

Q Why are generic drugs less expensive?

A According to the FDA, generic drugs are less expensive because generic manufacturers don’t have the investment costs of the developer of a new drug. Because the manufacturers of generic drugs don’t have the same development costs, they can sell their product at substantial discounts. Also, once generic drugs are approved, there is greater competition, which keeps the price down.

Q Why do generic drugs look different?

A Generic drug manufacturers are required by law to make their drugs look different from brand name products, so that consumers can easily tell them apart.

Q Does every drug have a generic?

A No. Generally when brand name drugs are first introduced,they are patent protected for up to 20 years before a generic alternative can be manufactured.

P.O. Box 7081, Bridgeport, CT 06601

HMHBFA02/5757

PRESORTED STANDARD

U.S. POSTAGE

PAID

ONWARD PUBLISHING INC.

importantinformation

insideCheck out the latest news

about your Oxford coverage

in the Membership updates

section of this issue and

start making the most

of your benefits.

CUSTOMER SERVI CE 800-444-6222 (8 AM - 6 PM, Mon to Fri)To reach a Service Associate, please call the toll-free Customer Service number on your Oxford ID card,or call 800-444-6222. For a hearing impaired interpreter you may contact Oxford’s TTY/TDD hotline at 800-201-4875. Please call 800-303-6719 for assistance in Chinese, 888-201-4746 for assistance in Korean,800-449-4390 para ayuda en Español, and for all other languages, call the number on your Oxford ID card.

OXFORD ON-CALL® 800-201-4911 (24 hours a day, 7 days a week)Registered nurses offer you healthcare guidance, around the clock.

PHARMACY CUSTOMER SERVICE LINE 800-905-0201 (24 hours a day, 7 days a week)Receive answers to your questions about pharmacy benefits, claims, prescriptions, and participating pharmacies in your area.

MEDCO HEALTH HOME DELIVERY PHARMACY SERVICE™

800-905-0201 (24 hours a day, 7 days a week)This mail-order pharmacy service provides a cost-effective,convenient way for Members with a mail-order prescription benefit to order certain maintenance medications.

OXFORD EXPRESS® 800-444-6222 (24 hours a day, 7 days a week)Touch-tone phone options let you confirm eligibility, check the status of a claim, request a new Member ID card or physician roster, and more.

OXFORD’S FRAUD HOTLINE 800-915-1909 (24 hours a day, 7 days a week)If you suspect healthcare fraud on the part of Members, employers, or providers, please call our confidentialfraud hotline.

DIABETES PROGRAM LINE 888-585-0631 (8 AM - 4:30 PM, Mon to Fri)Program coordinators provide information about Oxford’s Living with DiabetesSM program, or send educationalmaterials upon request.

BEHAVIORAL HEALTH LINE 800-201-6991 (8 AM - 6 PM, Mon to Fri)Behavioral health coordinators provide information such as referrals to behavioral health providers or precertification for mental health or substance abuse services.

ASTHMA PROGRAM LINE 888-201-4254 (8 AM - 4:30 PM, Mon to Fri)Program coordinators provide information about Oxford’s Better Breathing® program, or send educational materials upon request.

RESOURCES ON THE INTERNET AT www.oxfordhealth.com

MY OXFORDSM

Log on to access your policy and benefit information, and perform transactions such as checking claims status, selecting a primary care physician, and ordering materials and Member ID cards.

WELLNESS RESOURCES

Learn more about Oxford’s various wellness resources, such as our Healthy BonusSM program and Self-Help LibrarySM by logging on to our Member web site and clicking on the oxfordhealth Center.

OO X F O R D C O N T A C T I N F O